Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca / Epidemiological events related to decompensated heart failure

Objetivo: El presente estudio pretende conocer el perfil del paciente que ingresa por descompensación de insuficiencia cardíaca en un hospital de tercer nivel asistencial. Métodos: Se diseña un estudio observacional y retrospectivo en el que se registra de forma aleatoria los ingresos por este proceso en nuestro centro durante el año 2005. Resultados: El tamaño muestral es de 209 pacientes (media de edad: 78,6 ± 9,1; 52,4% varones), con un índice de comorbilidades del 87,55%. Casi un tercio de los pacientes no disponen de valoración de la función sistólica y entre los restantes, la gran mayoría (72,4%) presentan función sistólica conservada. La gran mayoría de las descompensaciones surgen en el seno de infecciones respiratorias. La cardiopatía isquémico-hipertensiva es el origen más frecuente de la cardiopatía con disfunción sistólica. Se registró una estancia hospitalaria media de 12,9 días con un índice de mortalidad del 9,56% resultando sus principales factores de riesgo estadíos funcionales avanzados en las escalas de la NYHA o de la Cruz Roja así como la presencia de demencia o ictus. Conclusiones: El presente estudio muestra un perfil del paciente hospitalizado por descompensación de insuficiencia cardíaca que difiere notablemente de aquel incluído en los grandes ensayos clínicos, lo que sin duda dificulta la aplicación de estrategias terapéuticas que han demostrado ser útiles en aquellos casos

Objective: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. Methods: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. Results: 209 patients were collected (average age: 78.6 ± 9.1; male:52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology ofsystolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. Conclusions: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful

[Epidemiological events related to decompensated heart failure]. / Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca.

OBJECTIVE: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. METHODS: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. RESULTS: 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. CONCLUSIONS: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.

Neumonía por Mycoplasma pneumoniae y síndrome de distrés respiratorio del adulto / Mycoplasma pneumoniae pneumonia ad adult respiratory distress syndrome

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Insuficiencia cardíaca. Diagnóstico insuficiente / Heart failure. Insuficient diagnostic

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[Pacemaker endocarditis]. / Endocarditis del marcapasos.

Pacemaker endocarditis is a rare but serious complication of permanent transvenous pacing. The most common presentation is fever syndrome or gram positive bacteremia. For the diagnostic it is important to performed blood cultures and an echocardiography. A retrospective study included the cases of pacemaker endocarditis diagnosed in the Internal Medicine Department of our Hospital between 1989-2003. Six patients were included. Repeated manipulation of the system and diabetes were the most frequent risk factors. The most frequently detected causative microorganisms were Staphylococci. In spite of the low sensitivity of the transthoracic echocardiography in expert hands it can improve, in this series it places in 66 %. Surgical treatment with cardiopulmonary bypass and implantation of a new system was performed in the same intervention in all patients. None relapsed and the overall mortality was 17%.

Endocarditis del marcapasos / Pacemaker endocarditis

La endocarditis del marcapasos es una complicación poco frecuente pero grave. La forma más frecuente de presentación es como síndrome febril y/o bacteriemia por gérmenes gram positivos. Dos elementos claves para el diagnóstico son los hemocultivos y el ecocardiograma. Se realiza un análisis retrospectivo de los pacientes con endocarditis del marcapasos ingresados en el Servicio de Medicina Interna de nuestro hospital entre 1989-2003. Se incluyeron 6 pacientes. En este estudio la manipulación repetida del sistema y la diabetes mellitus fueron los factores de riesgo más frecuentes. Los microorganismos más frecuentemente implicados fueron los Staphylococcus spp. A pesar de la menor sensibilidad del ecocardiograma transtorácico, en manos expertas puede mejorar su rendimiento, en esta serie se sitúa en el 66%. Se realizó extracción mediante cirugía extracorpórea e implantación de un nuevo sistema en la misma intervención en todos, sin ningún caso de recidiva y con una mortalidad del 17%

Pacemaker endocarditis is a rare but serious complication of permanent transvenous pacing. The most common presentation is fever syndrom or gram positive bacteremia. For the diagnostic it is important to performed blood cultures and an echocardiography. A retrospective study included the cases of pacemaker endocarditis diagnosed in the Internal Medicine Department of our Hospital between 1989-2003. Six patients were included. Repeated manipulation of the system and diabetes were the most frequent risk factors. The most frequently detected causative microorganisms were Staphylococci. In spite of the low sensitivity of the transthoracic echocardiography in expert hands it can improve, in this series it places in 66 %. Surgical treatment with cardiopulmonar bypass and implantation of a new system was performed in the same intervention in all patients. None relapsed and the overall mortality was 17%

[Pacemaker endocarditis]. / Endocarditis del marcapasos.

In the last years an increment has taken place in the pacemaker and implantable cardioverter-defibrillator indications that will have as consequence an increase of the prevalence of endocarditis associated to intravascular devices, for what acquires special relevance for the clinician to know this entity and to include it in his differential diagnoses. The objective of this article is to describe the epidemiology, clinic characteristics, diagnosis, treatment and outcome of the pacemaker endocarditis.

[Splenic abscess: presentation of nine cases]. / Abscesos esplénicos: presentación de nueve casos.

Relatively rare, splenic abscess is difficult to diagnose and often fatal if left untreated. The disease is thought to be growing in frequency because of the increasing number of inmunocompromised patients. Several mechanisms for the development of splenic abscess may exist. Some studies demonstrate that prior splenic injury in addition to bacteraemia is required for a splenic abscess to occur. In our series, 9 non immunocompromised patients were identified to have this disease during a 6 years period. Pathogens isolated included Salmonella sp, Staphylococcus sp and Enterococcus sp. Splenectomy was performed in three patients; in another a percutaneous drainage was done. One patient died. In summary, though rare, splenic abscess presents with high morbidity and mortality. In our experience, risk factors as immunocompromise seem not to be so prevalent in patients with splenic abscess and therefore this diagnosis should be considered in all patients with fever of unknown origin.

Endocarditis del marcapasos / Pacemaker endocarditis

En los últimos años se ha producido un incremento en las indicaciones de marcapasos y desfibriladores autoimplantables que tendrá como consecuencia un aumento de la prevalencia de la endocarditis asociada a dispositivos intravasculares, por lo que adquiere especial relevancia para el clínico conocer esta entidad e incluirla en sus diagnósticos diferenciales. El objetivo de este articulo es describir la epidemiología, características clínicas, diagnóstico, tratamiento y pronóstico de la endocarditis asociada al marcapasos

In the last years an increment has taken place in the pacemaker and implantable cardioverter-defibrillator indications that will have as consequence an increase of the prevalencia of the endocarditis associated to intravascular devices, for what acquires special relevance for the clinical one to know this entity and to include it in his differential diagnoses. The objetive of this article is to describe the epidemiology, clinic characteristics, diagnosis, treatment and outcome of the pacemaker endocarditis

Sarcoidosis extrapulmonar como causa de enfermedad hepática crónica. Presentación de un caso / Extrapulmonary sarcoidosis as a cause of chronic liver disease. Report of one case

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[Controversies in infective endocarditis]. / Controversias en endocarditis infecciosas.

The infective endocarditis is defined mainly as the infection of the internal surface of the heart, affecting to the cardiac valves although it can also do it to the septos, the tendinosas cords or endocardio mural. Around the origin, the diagnosis and the treatment of the disease, a considerable controversy has taken place. In this sense, basic criteria exist that they define to the infective endocarditis; however, particular situations are appraised in which the meticulous study is essential from the patient, doing special reference to the origin agents and, more in particular, to the fungal endocarditis.

[Drug interactions in the prescription of medical patients at hospital discharge]. / Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna.

OBJECTIVES: To detect and evaluate the clinical significance of drugs interactions in patients discharged from hospital. MATERIAL AND METHODS: We retrospectively screened the medication for potential drug interactions of 412 patients discharged. Interactions were catalogued according to clinical importance following the Hansten and Horn's classification. RESULTS: Three hundred twenty-nine potential interactions were detected. The 39.9% of the patients had at least one potentially interacting drug combination. The 52.6% of the interactions were catalogued as Class 3, bearing in mind minimizing the risk of the interaction. We did not find any Class 1 or 2 interactions, which have potentially major severity. Oral anticoagulants and digoxin were the most frequently implicated drugs. The patient monitoring was well done in the 100% of the interactions of Oral anticoagulants with other drug, but in the interactions of digoxin with another, this control was not done adequately. One patient was rehospitalised due to high levels of digoxin, he had been discharged with two potential interactions. CONCLUSIONS: The frequently of potential drug interactions in medical patients at hospital discharged was high, but the clinical significance appear to be low.

[Spondylodiskitis caused by Candida albicans. Report of two new cases]. / Espondilodiscitis por Candida albicans. Aportación de dos nuevos casos.

Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year old man and a 35 year old woman. Both were IDUs with a previous history of HIV infection. The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases.

[Partial bilateral rupture of the Achilles tendon associated to levofloxacin]. / Rotura parcial bilateral aquílea asociada a levofloxacino.

Fluoroquinolones-associated tendonitis and tendon rupture are well described in the literature but these are not frequently observed and related to the new agents of this group, as levofloxacin. This is probably due to the recent introduction and expansion. Although epidemiological studies are needed to know the frequency of that levofloxacin-induced tendinopathies, case-report could alert to the physicians about this possible severe adverse reaction. We present a case of bilateral Achilles tendonitis with partial spontaneous rupture probably associated to levofloxacin.

Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna / Drug interactions in the prescription of medical patients at hospital discharge

Objetivos: Estimar la frecuencia y valorar la relevancia teórica y repercusión clínica real de las interacciones medicamentosas en pacientes dados de alta desde un área médica. Material y métodos: Se revisan los tratamientos al alta de 412 pacientes de forma aleatoria. Se identifican las potenciales interacciones usando la Guía de Terapia Farmacológica Medimecum. Para la clasificaciónsegún su relevancia clínica teórica se usa la propuesta por Hansten y Horn. Resultados: Se encuentran 329 interacciones teóricas. El 39,9% de los pacientes presentaban al menos una interacción [IC 95%, 34,9%-44,9%]. El 52,6% de las interacciones eran clase 3 según Hansten, aquellas en las que ha de tomarse alguna medida para disminuir el riesgo de efectos indeseables. No se encontró ninguna interacción clase 1 ó 2 de Hansten, categorías de mayor gravedad. Las interacciones clase 3 más frecuentes implican a anticoagulantes orales y digoxina. Las medidas de control fueron realizadas en el 100% de los casos para las interacciones entre anticoagulantes orales y otros fármacos. En las interacciones de digoxina y otros fármacos las medidas de control recomendadas no fueron realizadas suficientemente. Un paciente reingresó con niveles porencima de rango de digoxina, habiendo sido dado de alta con dos potenciales interacciones. Conclusiones: La frecuencia de interacciones en pacientes dados dealta desde el área médica es alta. La relevancia teórica y la práctica parece ser baja

Objectives: To detect and evaluate the clinical significance of drugs interactions in patients discharged from hospital. Material and methods: We retrospectively screened the medication for potential drug interactions of 412 patients discharged. Interactions were catalogued according to clinical importance following the Hanstenand Horn’s classification. Results: Three hundred twenty-nine potential interactions were detected. The 39.9% of the patients had at least one potentially interactingdrug combination. The 52.6% of the interactions were catalogued as Class 3, bearing in mind minimizing the risk of the interaction. We did not find any Class 1 or 2 interactions, which have potentially major severity.Oral anticoagulants and digoxin were the most frequently implicated drugs. The patient monitoring was well done in the 100% of the interactions of Oral anticoagulants with other drug, but in the interactions of digoxin with another, this control was not done adequately. One patientwas re-hospitalised due to high levels of digoxin, he had been discharged with two potential interactions. Conclusions: The frequently of potential drug interactions in medical patients at hospital discharged was high, but the clinical significance appear to be low